Breast Cancer最新文献

Background: In ER + /HER2- early breast cancer (BC), 21-Gene Recurrence Score (RS) > 25 indicates high-risk of distant-recurrence and predicts benefit from adjuvant chemotherapy (aCT) regardless of tumor-size. However, T1a/b (≤ 1 cm) node-negative (N0) tumors, regarded as of low risk of recurrence, were under-represented in the RS trials. We therefore aimed to investigate the benefit of aCT in patients with T1a/bN0 BC, RS > 25, where clinical and genomic risk indicators are discordant.

Methods: This retrospective observational cohort study utilized Israel's national Oncotest database to identify Clalit Health Services (CHS) members, diagnosed with T1a/bN0 HR + /HER2- BC, who underwent RS testing between February 2006, and December 2019. Patients with RS > 25 who received aCT were matched 1:1 by propensity-scoring to similar patients receiving no aCT. Invasive disease-free survival (iDFS) and distant recurrence were the study endpoints. Patient demographic and clinical data were obtained from CHS's centralized database. Kaplan--Meier analysis with log-rank testing was used for comparing outcomes.

Results: During the study period, high-risk RS result (> 25) was identified in 156/9858 patients of the study cohort. aCT was administered to 74 (47.4%) and median follow-up was 121 months. Within the 148 matched-cases, eighteen iDFS-events occurred, nine (12.1%) in each group (χ² = 0.72, p = 0.39). Four (5.4%) of the aCT treated and three (4.0%) of the untreated patients were diagnosed with distant recurrence (χ² = 0.22, p = 0.64).

Conclusions: In this study cohort, patients with T1a/bN0 BC, RS > 25 that received aCT, did not have improved outcomes and the 21-Gene RS > 25 was not found to be predictive, possibly due to the low number of events observed.

Background: The gastrointestinal microbiota can modulate systemic estrogens, potentially influencing estrogen-induced breast neoplasia development. This study aimed to assess alterations in the gut microbiota in breast cancer patients.

Methods: A search strategy was developed using the terms: "Microbiota," "Gastrointestinal Microbiome," "Breast Cancer," and synonyms. Ten observational studies were included.

Results: The total sample was 1730 women (929 cases and 801 controls). The meta-analysis of alpha diversity, assessed by the Shannon index, displayed that in the breast cancer group, the diversity of the gut microbiota was reduced compared to controls, with a standardized mean difference (SMD) of - 0.34 (95% CI - 0.59, - 0.10, I² = 68%, p = 0.007). Regarding the premenopausal population, there was a significant reduction in the breast cancer group (SMD - 0.67, 95% CI - 1.06, - 0.28, I² = 77%, p = 0.0009). In women with a body mass index (BMI) between overweight or obesity, no statistically significant difference was observed (SMD - 0.20; 95% CI - 0.51, 0.11; I² 52%, p = 0.20). However, in women with a BMI greater than or equal to 18.5 and less than 25.0, there was lower diversity in women with breast cancer compared to controls (SMD - 0.49, 95% CI - 0.94, - 0.04; I² 78%, p = 0.03).

Conclusions: The study found a significant difference in gut microbiota diversity between women with breast cancer and controls, supporting the growing evidence that the gut microbiota may play a role in mammary carcinogenesis.

Background: In this study, we aimed to evaluate color differences of the skin paddle in autologous breast reconstruction performed using the deep inferior epigastric artery perforator (DIEP) flap and the profunda artery perforator (PAP) flap. The primary focus was to compare the color match between the reconstructed breast skin and the donor-site skin, to achieve optimal esthetic results.

Methods: A retrospective analysis was performed on patients who had undergone unilateral breast reconstruction with a DIEP flap or a PAP flap between January 2020 and December 2022. The colors were captured using a digital camera and analyzed using Adobe Photoshop 2024 software. The L*, a*, and b* coordinates were used. The International Commission on Illumination Delta E 2000 (CIEDE2000) score was used to quantify color differences, comparing skin tones of the unaffected breast, DIEP flap, PAP flap, abdomen, and medial thigh.

Results: A total of 125 patients were analyzed. The DIEP flap demonstrated a closer color match to the native breast skin compared with the PAP flap (CIEDE2000 scores, 5.29 vs. 8.69, p < 0.01). No significant difference in color deformity with time was found between the DIEP flap and the PAP flap (CIEDE2000 scores, 5.61 vs. 8.25, p = 0.17).

Conclusion: Our findings suggest that the DIEP flap results in a more favorable color match for breast reconstruction than the PAP flap, enhancing esthetic outcomes. These results underscore the importance of considering skin color matching in flap selection for breast reconstruction surgery.

Aim: To establish the histological categorization of tumor‑associated stroma (TAS) that reflects the biological behavior of triple-negative breast cancer (TNBC).

Methods and results: One-hundred-and-twenty surgically resected cases of TNBC were examined. We histologically categorized the TAS in the invasive frontal region into two groups: mature stroma (MS) and immature stroma (IS). The designation of IS was applied for tumors in which the largest myxoid stroma filled a high-power magnification field. When there were no myxoid stroma that meet the criteria for IS, TAS was categorized as MS. The tumors with type MS were observed in 103 (85.8%) of patients, whereas 17 (14.2%) of patients had tumors with IS. In total, 72 out of 120 patients with TNBC exhibited high tumor-infiltrating lymphocytes (TILs) representing 60% of the cohort. The incidences of high TILs were 66% (68 out of 103) in the MS group but only 23.5% (4 of 17) in the IS group (p = 0.001). Progression-free survival (PFS) and overall survival (OS) curves were different between IS and MS groups (p < 0.001 each), and Cox multivariate regression analysis revealed that IS was an independent indicator for lower PFS and OS rates (p < 0.001; p = 0.008).

Conclusion: Our findings suggest that TAS characteristics, particularly the distinction between IS and MS, play a significant role in the prognosis of TNBC. The presence of IS, associated with poor prognosis and low TILs, contrasts with the favorable outcomes observed in cases with MS. Understanding these TAS dynamics could aid in identifying patients with varying prognostic outcomes in TNBC, necessitating further research into the mechanisms behind these observations.

Aims and objectives: Appropriately timed cessation of systemic anticancer treatments is an important part of a patient's quality of life (QoL). We aimed to determine the right time to discontinue systemic anticancer therapy (SACT) and switch to the best supportive care for patients with advanced breast cancer (BC) who are nearing the end of life.

Methods: We identified 200 BC patients who died within 30 days after palliative SACT. Laboratory parameters and Eastern Cooperative Oncology Group (ECOG) performance status (PS) were recorded when the patients received their last SACT and at the time of their penultimate treatment. The (Neutrophil-ECOG-LDH-Bilirubin) 'NELBI' score, created on the basis of the optimum cut-off points of ECOG PS, neutrophil count, bilirubin level, and lactate dehydrogenase (LDH) level, which can predict mortality within 30 days after SACT, was scored between 0 and 4. Patients were stratified on the basis of the NELBI score.

Results: A total of 4164 patients receiving palliative treatment for advanced BC were examined. A total of 4.8% of patients died within 30 days after SACT. The percentage of patients who died within 30 days after SACT among all deceased patients was 19.4%. The median time from the last systemic treatment to death was 19.5 ± 7.85 (95% CI 18.06-20.26) days, and the median time from the penultimate treatment to death was 43.0 ± 24.65 (95% CI 46.81-53.85) days. A total of 21.3%, 58.0%, 70.7%, and 88.9% of patients with NELBI scores of 0, 1, 2, and 3-4, respectively, died within 30 days after SACT. Compared with a NELBI score of 0, a NELBI score of 1 (OR = 5.095; 95% CI 2.654- 9.784; p < 0.001), a NELBI score of 2 (OR = 8.911; 95% CI 4.299-18.474; p < 0.001), and a NELBI score of 3-4 (OR = 29.500; 95% CI 6.135- 141.847; p < 0.001) was associated with significantly greater 30-day mortality. The AUC of the NELBI scoring for 30-day mortality prediction after SACT was 0.713.

Conclusions: The 'NELBI' scoring system has the potential to significantly improve patient care by guiding the appropriate discontinuation of SACTs in patients with BC.

Exosome markers, CD63 and CD81, belong to the tetraspanin family and are expressed in solid tumors. It has been reported that these tetraspanin family members are prognostic factors in some cancers. However, the expression of CD63 and CD81 in pathological breast cancer specimens has not been reported. It has been reported that CD63 promotes the proliferation of breast cancer cells in vitro through yes-associated protein (YAP). Therefore, in this study, the expression of tetraspanin family members, particularly CD63, CD81, and YAP were investigated in breast cancer tissue, by immunohistochemistry, to clarify the relationship between clinicopathological factors and prognosis. The number of CD63 and YAP double-positive breast cancer cells was significantly higher in patients with pathological T factor (pT) status (p = 0.030) and tended to be higher in patients with pathological N factor (pN) status (p = 0.054). Furthermore, the number of CD81 and YAP double-positive breast cancer cells was significantly higher in patients with histological grade (p = 0.015), pT status (p = 0.001), and Ki67 expression (p = 0.049), and tended to be higher in patients with pN status (p = 0.062) and TNM stage (p = 0.052). In addition, CD63 and YAP double-positive breast cancers and CD81 and YAP double-positive breast cancers were associated with shorter disease-free and breast cancer-specific survival, respectively. In conclusion, CD63 and YAP, and CD81 and YAP may serve as potential prognostic biomarkers in patients with breast cancer.

Purpose: Multicatheter interstitial brachytherapy (MIB) is an established technique of partial breast irradiation (PBI). However, postoperative catheter implant is an invasive, inconvenient, and skillful procedure. In this study, local control and cosmesis of perioperative interstitial brachytherapy (PIB) by intraoperative catheter implant were evaluated by comparing with those of whole breast irradiation (WBI) following breast-conserving surgery (BCS).

Methods: Between October 2007 and August 2019, consequent patients who underwent either PIB or WBI following BCS were included. In general, additional indications for PIB to WBI included age ≥ 40 years, tumor ≤ 3 cm, and pN0 or pNmi. WBI was initiated with a total dose of 50 Gy in 25 fractions, whereas PBI was delivered immediately following BCS at 32 Gy in eight fractions. Local recurrence (LR) was the primary endpoint, and subjective and objective cosmetic outcomes at 5 years using the Harvard Cosmesis Scale and BCCT.core software, respectively, were the secondary endpoints.

Results: During the 10-year follow-up, the crude rate of LR was 3.8% (95% confidence interval [CI] 2.3-5.4) in 577 patients receiving PIB and 3.3% (95% CI 1.1-5.6) in 241 patients receiving WBI (P = 0.73). The 5- and 10-year LR-free survival rates in the PBI and WBI cohorts were 97.9% versus 97.9% and 95.4% versus 96.8%, respectively (P = 0.64). Multivariate analysis selected age < 50 years as an independent risk factor for LR. Excellent or good cosmesis in the PBI and WBI cohorts assessed by subjective and objective measures was 89.5% versus 84.5% (P = 0.26) and 83.7% versus 68.1% (P < 0.005), respectively.

Conclusions: Although this study was based on a retrospective chart review in a single institution, the largest series of data with a long follow-up suggested that acceptable local tumor control and cosmesis were achieved following PIB compared with WBI.

Background: The accuracy of mammography in breast cancer screening is influenced by different factors such as breast composition. However, previous studies did not evaluate the impact of breast size on examination accuracy. This study aimed to investigate the influence of breast size on the accuracy of mammography and ultrasonography in breast cancer screening using compressed breast thickness (CBT) on mammography as an indicator of breast size.

Methods: This study included Japanese women in their 40 s who underwent mammography alone (MG group) or mammography with adjunctive ultrasonography (MG + US group) at the Iwate Cancer Society (Iwate, Japan) in 2018 and 2019. Based on CBT, the participants were further divided into the L group (< 30 mm) and U group (≥ 30 mm). The recall rate, cancer detection rate, and positive predictive value of the L and U groups based on screening method and breast size were evaluated.

Results: Of 15,897 patients, 10,162 and 5735 underwent mammography alone and mammography with adjunctive ultrasonography, respectively. In the L group, the MG and MG + US groups did not significantly differ in terms of recall rate (1.9%, 95% CI 1.4-2.6 vs 1.9%, 1.2-2.9; p = 0.972). Moreover, the MG + US group had a higher cancer detection rate than the MG group. However, the difference was not significant (0.20%, 0.05-0.51 vs 0.63%, 0.25-1.29; p = 0.054). In the U group, the MG + US group had a significantly higher recall rate than the MG group (2.2%, 1.9-2.5 vs 2.9%, 2.5-3.4; p < 0.05). Nevertheless, there was no significant difference in the cancer detection rate (0.15%, 0.08-0.25 vs 0.28%, 0.15-0.48; p = 0.099).

Conclusions: To the best of our knowledge, this study first showed that breast size, in addition to breast composition, influences the accuracy of mammography and ultrasonography in breast cancer screening. Hence, screening methods tailored to individual breast characteristics should be considered.

This is an annual report by the Japanese Breast Cancer Society, which provides statistics on the clinical data on breast cancer in Japan, extracted from the National Clinical Database-Breast Cancer Registry (NCD-BCR). This report includes an update of 102,453 breast cancer cases at 1339 institutions registered in the NCD-BCR in 2022. Among the 101,793 female patients, the median age at cancer diagnosis was 62 years (interquartile range, 50-73 years), and 29.4% of the patients were premenopausal. Of these patients, 15,437 (15.2%) and 42,936 (42.2%) were diagnosed with stage 0 and I disease, respectively. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) were positive in 78.7%, 69.4%, and 12.8% of the patients, respectively. Of the 97,154 patients without distant metastasis, 40,521 (41.7%) underwent breast-conserving surgery, and 5780 (5.9%) patients underwent some form of breast reconstruction procedures at the time of mastectomy. A total of 66,894 (68.9%) patients were treated with sentinel lymph node biopsy and 7155 (7.4%) patients were treated with sentinel lymph node biopsy followed by axillary node dissection. In the group of patients treated with breast-conserving surgery (n = 40,521), 29,500 (72.8%) received whole-breast irradiation. In the group of patients who underwent mastectomy (n = 54,476), 6226 (11.4%) received radiation therapy to the chest wall. Of the 13,950 patients receiving preoperative chemotherapy with or without molecular targeted therapy, 4308 (30.9%) achieved a pathological complete response, with the highest rate of 60.5% in patients with the hormone receptor-negative/HER2-positive subtype.

Background: Systemic therapy (ST) is essential for de novo stage IV breast cancer (BC). Stage IV BCs are highly heterogeneous, and it seems inappropriate to treat all de novo stage IV BCs equally. The survival benefit of surgery for primary sites in patients with de novo stage IV BC remains inconclusive.

Patients and methods: We investigated 220 patients with clinical de novo stage IV BC. The relationship between primary site surgery and overall survival (OS) was analyzed. Factors such as tumor subtype, timing of surgery, and efficacy of ST were also evaluated.

Results: The median follow-up time was 37.9 (0.5-201.7) months. In the total cohort, the median OS of the patients with and without primary site surgery was 70.5 months (95% confidence interval [CI] 58.4-107.3) and 42.7 months (95% CI 35.7-48.8), respectively. The OS was significantly longer in patients who underwent primary site surgery, especially in the hormone receptor (HR) + /HER2- and HER2 + subtypes, but not in the triple-negative subtype. OS prolongation was significant in patients who underwent surgery ≥ 24 months after the first diagnosis and in whom the first-line ST was effective for ≥ 24 months. Primary site surgery was a good prognostic factor in both univariate and multivariate analyses.

Conclusions: The OS was significantly longer in patients with de novo stage IV BC who underwent primary site surgery than in those who did not undergo surgery. Our results suggest that the tumor subtypes, efficacy of ST, and timing of surgery influenced the benefits of surgery.